Punctal plugs

ABSTRACT

Punctal plugs for delivering therapeutic agents have a body, a portion into which the therapeutic agent is held, a winding about the body, and an enlarged portion or anchor at an end.

CROSS REFERENCE TO RELATED APPLICATIONS

This patent application is a continuation-in-part of U.S. patentapplication Ser. No. 12/749,085, filed Mar. 29, 2010.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to devices for delivering therapeuticagents to one or more of the eye, nose and throat, and moreparticularly, to punctal plugs for delivering therapeutic agents to oneor more of the eye, nose and throat.

2. Discussion of the Related Art

Human tears are secreted by the lacrimal gland and flow across thesurface of the eye to a shallow pool, known as the lacrimal lake,located where the eyelids come together at their inner ends. From there,the tears drain through small openings in each of the upper and lowereyelids, termed the superior lacrimal punctum and the inferior lacrimalpunctum, respectively. From the superior and inferior puncta, the tearspass into each of the superior and inferior lacrimal canaliculus,respectively, which are duct-like pathways that lead to the lacrimalsac. The lacrimal sac is the superior, expanded portion of thenasolacrimal duct, which drains tears into the nasal system. Activeand/or therapeutic agents can thus be delivered to the nose and throatthrough the lacrimal canaliculi, which lead into the nasolacrimal duct.

Active agents frequently are administered to the eye for the treatmentof ocular diseases and disorders. Conventional means for deliveringactive agents to the eye involve topical application to the surface ofthe eye. The eye is uniquely suited to topical administration because,when properly constituted, topically applied active agents can penetratethrough the cornea, conjunctiva or sclera and rise to therapeuticconcentration levels inside the eye. Active agents for ocular diseasesand disorders may be administered orally or by injection, but suchadministration routes are disadvantageous in that, in oraladministration, the active agent may reach the eye in too low aconcentration to have the desired pharmacological effect and their useis complicated by significant, systemic side effects, while injectionspose the risk of infection, discomfort, bleeding or perforation of theglobe.

The majority of ocular active agents are currently delivered topicallyusing eye drops which, though effective for some applications, areinefficient. When a drop of liquid is added to the eye, it overfills theconjunctival sac, the pocket between the eye and the lids, causing asubstantial portion of the drop to be lost due to overflow of the lidmargin onto the cheek. In addition, a substantial portion of the dropthat remains on the ocular surface is drained into the lacrimal puncta,diluting the concentration of the drug.

To compound the problems described above, patients often do not usetheir eye drops as prescribed. Often, this poor compliance is due to aninitial stinging or burning sensation caused by the eye drop. Certainly,instilling eye drops in one's own eye can be difficult, in part becauseof the normal reflex to protect the eye. Therefore, sometimes one ormore drops miss the eye. Older patients may have additional problemsinstilling drops due to arthritis, unsteadiness, and decreased vision,and pediatric and psychiatric patient populations pose difficulties aswell.

It is known to use devices that may be inserted into one or more of anorifice of an individual's eye, such as a lacrimal punctum, to deliveractive agents. These punctal plugs may be configured for customizeddelivery of the active agents in terms of dosage and duration; however,as each individual's eye anatomy is unique, placement and anchoring ofthe punctal plug in the puncta may present certain difficulties.Accordingly, there exists a need for punctal plugs that are configuredfor ease of placement and anchoring while delivering an active agentover a predetermined treatment period.

SUMMARY OF THE INVENTION

The punctal plugs in accordance with the present invention overcome thelimitations associated with the prior art as briefly described above.

In accordance with one aspect, the present invention is directed to alacrimal insert for delivering one or more active agents. The lacrimalinsert for delivering one or more active agents comprises an elongatedmain body having a first end and a second end, the elongated main bodyincluding a reservoir, a collarette connected to the first end of themain body and having at least one opening in fluid communication withthe reservoir, the collarette being concentrically positioned relativeto the elongated main body, and a head section connected to the secondend of the elongated main body, the head section including a flangeportion having a substantially disc shaped configuration, and a coneportion, the flange portion and the cone portion beingnon-concentrically positioned relative to the elongated main body.

In accordance with another aspect, the present invention is directed toa lacrimal insert for delivering one or more active agents. The lacrimalinsert for delivering one or more active agents comprises an elongatedmain body having a first end and a second end, the elongated main bodyincluding a reservoir, a collarette connected to the first end of themain body and having at least one opening in fluid communication withthe reservoir, the collarette being concentrically positioned relativeto the elongated main body, and a head section connected to the secondend of the elongated main body, the head section including a flangeportion having a lower surface with a spherical cone shape and an uppersurface that is substantially bowl shaped, and a cone portion, theflange portion and the cone portion being non-concentrically positionedrelative to the elongated main body.

In accordance with still another aspect, the present invention isdirected to a lacrimal insert for delivering one or more active agents.The lacrimal insert for delivering one or more active agents comprisesan elongated main body having a first end and a second end, theelongated main body including a reservoir and a threaded portion, acollarette connected to the first end of the main body and having atleast one opening in fluid communication with the reservoir, thecollarette being concentrically positioned relative to the elongatedmain body, and a head section connected to the second end of theelongated main body, the head section including a flange portion havinga lower surface with a spherical cone shape and an upper surface that issubstantially flat, and a cone portion, the flange portion and the coneportion being non-concentrically positioned relative to the elongatedmain body.

The present invention is directed to punctual plugs sized to passthrough a lacrimal punctum and be positioned within a lacrimalcanaliculis of the eyelid and which comprises one or more therapeuticagents for controlled release into the eye. The punctual plug isconfigured for easy insertion and long term stability. The plug isconfigured to hold the one or more therapeutic agents and release theseone or more agents into the eye for treatment of a particular conditionof the eye.

The exemplary punctal plugs of the present invention are designed toimprove anchoring in the anatomy. The devices utilize variousconfigurations, including offset distal ends and threads to improveanchoring and retention. These design modifications have minimal impacton manufacturability and cost.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other features and advantages of the invention will beapparent from the following, more particular description of preferredembodiments of the invention, as illustrated in the accompanyingdrawings.

FIGS. 1A and 1B are diagrammatic views of a first exemplary punctal plugin accordance with the present invention.

FIGS. 1C and 1D are sectional views of the first exemplary punctal plugsillustrated in FIGS. 1A and 1B taken along section lines 1C-1C and1D-1D.

FIGS. 2A and 2B are diagrammatic views of a second exemplary punctalplug in accordance with the present invention.

FIGS. 2C and 2D are sectional views of the second exemplary punctalplugs illustrated in FIGS. 2A and 2B taken along section lines 2C-2C and2D-2D.

FIGS. 3A and 3B are diagrammatic views of a third exemplary punctal plugin accordance with the present invention.

FIGS. 3C and 3D are sectional views of the third exemplary punctal plugsillustrated in FIGS. 3A and 3B taken along section lines 3C-3C and3D-3D.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Punctal plugs have been in use for decades now to treat conditions ofdry eye. More recently they have gained attention for use as drugdelivery systems for the treatment of ocular diseases and conditions.Several challenges exist with formulating a drug to release at thedesired daily rate and or dose that will give efficacy while limitingadverse events.

Diffusion based drug delivery systems are characterized by the releaserate of a drug. This is dependent on its diffusion through an inertwater insoluble membrane barrier. There are basically two diffusiondesigns: reservoir devices and matrix devices. Reservoir devices arethose in which a core of drug is surrounded by a polymeric membrane. Thenature of the membrane determines the rate of release of a drug fromsystem. The process of diffusion is generally described by a series ofequations governed by Fick's first law of diffusion. A matrix deviceconsists of drug dispersed homogenously throughout a polymer structure.

Reservoir and matrix drug delivery systems are considered diffusionbased sustained release systems and constitute any dosage form thatprovides medication over an extended period of time. The goal of asustained release system is to maintain therapeutic levels of drug foran extended period and this is usually accomplished by attempting toobtain zero-order release from the sustained release system. Sustainedrelease systems generally do not attain this type of release profile buttry to approximate it by releasing the drug in a slow first ordermanner. Over an extended period of time, the drug release rate fromreservoir and matrix sustained release systems will decay and become nontherapeutic.

Zero-order drug release constitutes drug release from a drug deliverysystem at a steady sustained drug release rate, that is, the amount ofdrug that is released from the drug delivery system over equal timeintervals does not decay and remains at the therapeutic level. This“steady sustained release drug delivery system” is referred to as azero-order drug delivery system and has the potential to provide actualtherapeutic control by its controlled release. Another drug releaseprofile is referred to as pulsatile drug delivery. Pulsatile drugdelivery is intended to release a therapeutic amount of a therapeuticagent at regular intervals.

The punctal plugs in accordance with the present invention may beutilized to deliver active and/or therapeutic agents to one or both ofthe nasolacrimal duct and to the tear film of the eye. In one exemplaryembodiment, the punctal plug comprises a main body, including reservoir,and having a proximal end and a distal end, a collarette connected tothe proximal end of the main body, and a head section, including aflange structure that is substantially flat on both sides, and asubstantially cone shaped section, aligned with the distal end of themain body. The collarette is concentrically aligned with the main bodywhile the head section is non-concentrically aligned with the main body.In another exemplary embodiment, the punctal plug comprises a main body,including a reservoir, and having a proximal end and a distal end, acollarette connected to the proximal end of the main body, and a headsection, including a flange structure that is substantially flat on oneside and rounded on the other side, and a substantially cone shapedsection, connected to the distal end of the main body. The collarette isconcentrically aligned with the main body while the head section isnon-concentrically aligned with the main body. The cone shaped sectionof this exemplary embodiment is more rounded that the previouslydescribed exemplary embodiment. In yet another exemplary embodiment, thepunctal plug comprises a main body, including a reservoir, and having aproximal end and a distal end, a collarette connected to the proximalend of the main body, and a head section, including a flange structurethat is substantially flat on one side and rounded on the other side,and a substantially cone shape section, connected to the distal end ofthe main body. The collarette is concentrically aligned with the mainbody while the head section is non-concentrically aligned with the mainbody. The cone shaped section of this exemplary embodiment is the sameas the previously described exemplary embodiment. The main body;however, differs from the other exemplary embodiments in that it alsocomprises threads from its proximal end to its distal end. A detaileddescription of each of the exemplary embodiments, is set forth below.

The present invention encompasses punctal plugs for the delivery ofactive agents to one or both of the tear film of the eye and to thenasolacrimal duct. The punctal plugs preferably are inserted into theinferior lacrimal canaliculis, the superior lacrimal canaliculus, orboth the inferior and superior lacrimal canaliculus. If the punctalplugs are being used to deliver active agents to the tear fluid of theeye, the punctal plugs preferably have a collarette at one end of themain body as described above. The collarette is a portion of the punctalplug that extends radially, outward from the end of the body to a degreesufficient and having a size and a shape such that at least a portion ofthe collarette will extend beyond and be exterior to the lacrimalpunctum after insertion of the punctal plug into the lacrimalcanaliculus. Typically, the collarette will extend about 0.2 to about 1mm beyond the main body. Essentially, the collarette rests against theinterior of the lacrimal punctum and keeps the punctal plug fromslipping down into the lacrimal canaliculus so that contact between thepunctal plug and the tear film of the eye is maintained. If the punctalplugs are being utilized to deliver active agent to the nasolacrimalduct, the punctal plugs may not comprise a collarette so that they maybe inserted to a sufficient depth within one or both of the lacrimalcanaliculi such that the active agent is released into the lacrimal sac.

As used herein, the term “punctal plug” refers to a device of a size andshape suitable for insertion into the inferior or superior lacrimalcanaliculus of the eye through, respectively, the inferior or superiorlacrimal punctum.

As used herein, the term “active agent” refers to an agent capable oftreating, inhibiting, or preventing a disorder or a disease. Exemplaryactive agents include pharmaceuticals and nutraceuticals. Preferredactive agents are capable of treating, inhibiting, or preventing adisorder or a disease of one or more of the eye, nose and throat.

As used herein, the term “a material that is at least partiallywater-soluble” refers to a material that exhibits a level of solubilityin water sufficient to result in detectable dissolution of the materialupon exposure to an aqueous environment.

As used herein, the term “a material that is biodegradable” refers to amaterial that degrades to a detectable degree upon exposure tobiologically active substances typically present in mammals.

As used herein, the term “a material that is insoluble in water” refersto a material that does not dissolve to a substantial degree uponexposure to water.

As used herein, the phrase “a material that is non-biodegradable” refersto a material that does not degrade to a substantial degree uponexposure to biologically active substances typically present in mammals.

As used herein, the phrase “body that is impermeable to active agent”refers to a body through which only an insubstantial amount of activeagent may pass.

As used herein, the term “polymeric material” refers to a material madeof one or more types of polymers that is capable of containing at leastone active agent and releasing the active agent, for example, when thepolymers dissolve or degrade, when the active agent diffuses from thepolymers, or when a pro-drug is used in which the active agent isattached to the polymers and then released by being cleaved from thematerial.

As used herein, the term “opening” refers to an opening in the body of apunctal plug of a size and shape through which the active agent canpass. Preferably, only the active agent can pass through the opening.The opening, for example, may be a hole covered with a membrane, mesh,grid or it may be uncovered. The membrane, mesh, or grid may be one ormore of porous, semi-porous, permeable, semi-permeable, andbiodegradable.

As used herein, the phrase “flexible material” refers to a material thatis not rigid and that substantially conforms to the surface of whateverobject the material contacts.

As used herein, the phrase “the reservoir and the body are coterminous”indicates that the reservoir is substantially all of the body. Acollarette can be attached to the body when the reservoir and body arecoterminous, but the collarette would not be considered to be part ofthe body.

As used herein, the phrase “refilled with active agent” refers to addingany detectable amount of active agent to the reservoir of a punctalplug.

Referring now to FIGS. 1A-1D, there is illustrated, in multiple views, afirst exemplary embodiment of a punctal plug 100. The punctal plug 100comprises a main body 102, a collarette 104 and a head section 106,including a flange portion 108 and a cone section 110. The main body 102includes a reservoir 112 which extends from the collarette 104 into thehead section 106. The main body 102 comprises a substantiallycylindrical shape as does the reservoir 112 therein. It is important tonote that the main body 102 may comprise any suitable shape and/or size.The reservoir 112 may also comprise any suitable shape, size andmaterial to hold and controllably release the active agent. Therefore,the reservoir 112 may extend to any portion of the device including thehead section 106.

The collarette 104 comprises a substantially disc shaped structure witha substantially flat upper surface 105, a substantially flat lowersurface 107 and a beveled edge 114, and is concentrically aligned withthe main body 102. In other words, the central axis of the collarette104 is aligned with the central axis of the main body portion 102. Thecollarette 104 is a section of the punctal plug 100 that extendsradially from the main body portion 102 to a degree sufficient, andhaving a size and shape, such that at least a portion of the collarette104 will extend beyond and be exterior to the lacrimal punctum afterinserting of the punctal plug 100 into the lacrimal canaliculus. Thecollarette 104 also comprises an opening 116 which is in fluidcommunication with the reservoir 112. Although a single opening 116 isillustrated, multiple openings may be utilized. The opening 116 allowsfluid in the reservoir 112 to exit the punctal plug 100 and enter theeye via the tear film. In this exemplary embodiment, the active agentsimply diffuses out of the reservoir 112. The rate at which the activeagent diffuses from the reservoir 112 depends on a number of factors,including the active agent itself and the materials mixed with theactive agent as is discussed in greater detail subsequently. Inalternate exemplary embodiments, active devices such as pumps may beutilized to deliver the active agents. The collarette 104 also comprisesa mark 118 for proper positioning of the punctal plug 100. As will bedescribed in greater detail subsequently, the punctal plug 100 has to bepositioned such that it anchors in the anatomy to achieve the best fitpossible; accordingly, the mark 118 indicates the direction of greateroffset of the head section 106 relative to the main body 102. The mark118 may comprise any suitable indicia which is visible to the physicianplacing the punctal plug 100. For example, the mark 118 may simplycomprise a hole or dimple on the upper surface 105 of the collarette104.

The head section 106 is non-concentrically aligned with the main body102. In other words, the central axis of the flange portion 108 and thecentral axis of the cone section 110 are not aligned with the centralaxis of the main body 102. This offset or non-concentric placementallows for better anchoring of the punctal plug in the canaliculus.Based upon eye anatomy, it should be understood that this offset designallows for better anchoring regardless of specific anatomicalvariations. Although the insertion force for the punctal plug 100 may begreater, the removal force will also be greater. Essentially, the headsection 106 is an enlarged portion of the punctal plug 100 that is ofsuitable size and shape for securing the punctal plug 100 in thelacrimal canaliculus. The flange portion 108 comprises a substantiallydisc shaped structure with a substantially flat upper surface 109, asubstantially flat lower surface 111, and a beveled edge 120. The conesection 110 comprises a rounded dome structure. The cone section 110 maycomprise any suitable shape, including an oblique circular cone, a rightelliptical cone or an oblique elliptical cone; however, the cone section110 preferably comprises a right circular cone. The cone section 110 andthe flange portion 108 may be connected by any suitable means, includingadhesives, overmoulding and welding; however, in a preferred exemplaryembodiment, they are formed as a single, unitary structure. In certainexemplary embodiments, the cone section 110 may comprise an opening 122through which the active agent may be delivered into the nasolacrimalduct. This opening may be in addition to the opening 116 in thecollarette 104 or as an alternate thereto. The opening 122 is in fluidcommunication with the reservoir 112. Either opening 116 or 122 may beutilized to refill the reservoir 112. Essentially, the opening throughwhich the active agent is released from the punctal plug 100 may belocated at either end thereof, or from any lateral surface thereof.

The punctal plug 100 may be fabricated from any number of suitablebiocompatible materials and manufactured utilizing any suitabletechniques as set forth in greater detail subsequently. The reservoir112 may be filled with one or more active agents to treat a wide varietyof conditions as set forth below.

Referring now to FIGS. 2A-2D, there is illustrated, in multiple views, asecond exemplary embodiment of a punctal plug 200. The punctal plug 200comprises a main body 202, a collarette 204 and a head section 206,including a flange portion 208 and a cone section 210. The main body 202includes a reservoir 212 which extends from the collarette 204 into thehead section 206. The main body 202 comprises a substantiallycylindrical shape as does the reservoir 212 therein. It is important tonote that the main body 202 may comprise any suitable shape and/or size.The reservoir 212 may also comprise any suitable shape, size andmaterial to hold and controllably release the active agent. Therefore,the reservoir 212 may extend to any portion of the device including thehead section 206.

The collarette 204 comprises a substantially disc shaped structure witha substantially flat upper surface 205, a substantially flat lowersurface 207 and a beveled edge 214, and is concentrically aligned withthe main body 202. In other words, the central axis of the collarette204 is aligned with the central axis of the main body portion 202. Thecollarette 204 is a section of the punctal plug 200 that extendsradially from the main body portion 202 to a degree sufficient, andhaving a size and shape, such that at least a portion of the collarette204 will extend beyond and be exterior to the lacrimal punctum afterinserting of the punctal plug 200 into the lacrimal canaliculus. Thecollarette 204 also comprises an opening 216 which is in fluidcommunication with the reservoir 212. Although a single opening 216 isillustrated, multiple openings may be utilized. The opening 216 allowsfluid in the reservoir 212 to exit the punctal plug 200 and enter theeye via the tear film. In this exemplary embodiment, the active agentsimply diffuses out of the reservoir 212. The rate at which the activeagent diffuses from the reservoir 212 depends on a number of factors,including the active agent itself and the materials mixed with theactive agent as is discussed in greater detail subsequently. Inalternate exemplary embodiments, active devices such as pumps may beutilized to deliver the active agents. The collarette 204 also comprisesa mark 218 for proper positioning of the punctal plug 200. As will bedescribed in greater detail subsequently, the punctal plug 200 has to bepositioned such that it anchors in the anatomy to achieve the best fitpossible; accordingly, the mark 218 indicates the direction of greateroffset of the head section 206. The mark 218 may comprise any suitableindicia which is visible to the physician placing the punctal plug 200.For example, the mark 218 may simply comprise a hole or dimple on theupper surface 205 of the collarette 204.

The head section 206 is non-concentrically aligned with the main body202. In other words, the central axis of the flange portion 208 and thecentral axis of the cone section 210 are not aligned with the centralaxis of the main body 202. This offset or non-concentric placementallows for better anchoring of the punctal plug in the canaliculus.Based upon eye anatomy, it should be understood that this offset designallows for better anchoring regardless of specific anatomicalvariations. Although the insertion force for the punctal plug 200 may begreater, the removal force will also be greater. Essentially, the headsection 206 is an enlarged portion of the punctal plug 100 that is ofsuitable size and shape for securing the punctal plug 200 in thelacrimal canaliculus. The flange portion 208 does not comprise asubstantially disc shaped structure as in the first exemplaryembodiment, but rather a unique rounded structure. As illustrated, thelower surface 211 of the flange 208 comprises a spherical cone shapewith a different angle than the cone section 210 and an upper surface209 that is substantially bowl shaped. Given its off axis attachment,the upper surface 209 also comprises two different depths. In the regionwhich extends the farther from the main body 202, the upper surface 209extends deeper towards the cone section 210 than the upper surface 209closer to the main body 202. The upper rim of the flange portion 208 isat the same height, but the unique configuration and off axis ornon-concentric positioning, allows for more secure anchoring in thecanaliculus. The cone section 210 comprises a rounded dome structure.The cone section 210 may comprise any suitable shape, including anoblique circular cone, a right elliptical cone or an oblique ellipticalcone; however, the cone section 210 preferably comprises a rightcircular cone. The cone section 210 and the flange portion 208 may beconnected by any suitable means, including adhesives, overmoulding andwelding; however, in a preferred exemplary embodiment, they are formedas a single, unitary structure. In certain exemplary embodiments, thecone section 210 may comprise an opening 222 through which the activeagent may be delivered into the nasolacrimal duct. This opening may bein addition to the opening 216 in the collarette 204 or as an alternatethereto. The opening 222 is in fluid communication with the reservoir212. Either opening 222 may be utilized to refill the reservoir 212.Essentially, the opening through which the active agent is released fromthe punctal plug 200 may be located at either end thereof, or from anylateral surface thereof. The rounded dome of this exemplary embodimentis more rounded than that of the rounded dome of the first exemplaryembodiment illustrated in FIG. 1.

The punctal plug 200 may be fabricated from any number of suitablebiocompatible materials and manufactured utilizing any suitabletechniques as set forth in greater detail subsequently. The reservoir212 may be filled with one or more active agents to treat a wide varietyof conditions as set forth below.

Referring now to FIGS. 3A-3D, there is illustrated, in multiple views, athird exemplary embodiment of a punctal plug 300. The punctal plug 300comprises a main body 302, a collarette 304 and a head section 306,including a flange portion 308 and a cone section 310. The main body 302includes a reservoir 312 which extends from the collarette 304 into thehead section 306. The main body 302 comprises a substantiallycylindrical shape as does the reservoir 312 therein. It is important tonote that the main body 300 may comprise any suitable shape and/or size.The main body 302 also comprises a threaded portion or threads 324running along the outer surface thereof. In the illustrated exemplaryembodiment, the threads 324 extend from the collarette 304 to the headsection 306. However, in alternate exemplary embodiments, the threads324 may extend any suitable length along the body. The threads 324 maybe formed directly on the surface of the main body 302 as part of asingle, unitary monolithic structure, or the threads 324 may beseparately formed from a suitable biocompatible material and attached tothe main body 302 by any suitable means, such as gluing or welding. Thethreads 324 may comprise any suitable pitch and/or lead and preferablyhave rounded edges to prevent damage to the surrounding tissue.Essentially, a thread or screw thread is a helical structure forconverting between rotational and linear movement, and is typically usedas a fastener. In this exemplary embodiment, the threads 324 act as afastener or anchor to secure the punctal plug 300 in position. Thereservoir 312 may comprise any suitable shape, size and material to holdand controllably release the active agent. Therefore, the reservoir 312may extend to any portion of the device including the head section 306.

The collarette 304 comprises a substantially disc shaped structure witha substantially flat upper surface 305, a substantially flat lowersurface 307 and a beveled edge 314, and is concentrically aligned withthe main body 302. In other words, the central axis of the collarette304 is aligned with the central axis of the main body portion 302. Thecollarette 304 is a section of the punctal plug 300 that extendsradially from the main body portion 302 to a degree sufficient, andhaving a size and shape, such that at least a portion of the collarette304 will extend beyond and be exterior to the lacrimal punctum afterinserting of the punctal plug 300 into the lacrimal canaliculus. Thecollarette 304 also comprises an opening 316 which is in fluidcommunication with the reservoir 312. Although a single opening 316 isillustrated, multiple openings may be utilized. The opening 316 allowsfluid in the reservoir 312 to exit the punctal plug 300 and enter theeye via the tear film. In this exemplary embodiment, the active agentsimply diffuses out of the reservoir 312. The rate at which the activeagent diffuses from the reservoir 312 depends on a number of factors,including the active agent itself and the materials mixed with theactive agent as is discussed in greater detail subsequently. Inalternate exemplary embodiments, active devices such as pumps may beutilized to deliver the active agents. The collarette 304 also comprisesa mark 318 for proper positioning of the punctal plug 300. As will bedescribed in greater detail subsequently, the punctal plug 300 has to bepositioned such that it anchors in the anatomy to achieve the best fitpossible; accordingly, the mark 318 indicates the direction of greateroffset of the head section 306 relative to the main body. The mark 318may comprise any suitable indicia which is visible to the physicianplacing the punctal plug 300. For example, the mark 318 may simplycomprise a hole or dimple on the upper surface 305 of the collarette304.

The head section 306 is non-concentrically aligned with the main body302. In other words, the central axis of the flange portion 308 and thecentral axis of the cone section 310 are not aligned with the centralaxis of the main body 302. This offset or non-concentric placementallows for better anchoring of the punctal plug in the canaliculus.Based upon eye anatomy, it should be understood that this offset designallows for better anchoring regardless of specific anatomicalvariations. Although the insertion force for the punctal plug 300 may begreater, the removal force will also be greater. Essentially, the headsection 306 is an enlarged portion of the punctal plug 300 that is ofsuitable size and shape for securing the punctal plug 300 in thelacrimal canaliculus. The flange portion 308 does not comprise asubstantially disc shaped structure as in the first exemplaryembodiment, but rather a unique rounded structure. As illustrated, thelower surface 311 of the flange 308 comprises a spherical cone shapewith a different angle than the cone section 310 and an upper surface309 that is substantially flat, similar to the first exemplaryembodiment. The upper rim of the flange portion 308 is at the sameheight, but the unique configuration and off axis or non-concentricpositioning, allows for more secure anchoring in the canaliculus. Thecone section 310 comprises a rounded dome structure. The cone section310 may comprise any suitable shape, including an oblique circular cone,a right elliptical cone or an oblique elliptical cone; however, the conesection 310 preferably comprises a right circular cone. The cone section310 and the flange portion 308 may be connected by any suitable means,including adhesives, overmoulding and welding; however, in a preferredexemplary embodiment, they are formed as a single, unitary structure. Incertain exemplary embodiments, the cone section 310 may comprise anopening 322 through which the active agent may be delivered into thenasolacrimal duct. This opening may be in addition to the opening 316 inthe collarette 304 or as an alternate thereto. The opening 322 is influid communication with the reservoir 312. Either opening 316 or 322may be utilized to refill the reservoir 312. Essentially, the openingthrough which the active agent is released from the punctal plug 300 maybe located at either end thereof, or from any lateral surface thereof.The rounded dome of this exemplary embodiment is more rounded than thatof the rounded dome of the first exemplary embodiment illustrated inFIG. 1.

The punctal plug 300 may be fabricated from any number of suitablebiocompatible materials and manufactured utilizing any suitabletechniques as set forth in greater detail subsequently. The reservoir312 may be filled with one or more active agents to treat a wide varietyof conditions as set forth below.

In all three exemplary embodiments set forth above, the reservoir isconfigured to contain one or more active agents to be released bydiffusion or any other suitable means. Therefore, the reservoir ispreferably configured to hold a sufficient quantity of the one or moreagents for a given period of time. The reservoir may also be configuredfor refilling through any of the openings therein for extended use. Ineach of the exemplary embodiments, the punctal plug is configured forsecure anchoring and retention.

The main body of the punctal plug may be wholly or partially transparentor opaque. Optionally, the main body may include a tint or pigment thatmakes the plug easier to see when it is placed in a punctum.

The main body of the punctal plugs may be made of any suitablebiocompatible material, including silicone, silicone blends, siliconeco-polymers, for example, hydrophilic monomers ofpolyhydroxyethlymethacrylate (“pHEMA”), polyethylene glycol,polyvinylpyrrolidone, and glycerol, and silicone hydrogel polymers, forexample, those described in U.S. Pat. Nos. 5,962,548, 6,020,445,6,099,852, 6,367,929, and 6,822,016, incorporated herein in theirentireties by reference. Other suitable biocompatible materials includepolyurethane; polymethylmethacrylate; poly(ethylene glycol);poly(ethylene oxide); polypropylene glycol); poly(vinyl alcohol);poly(hydroxyethyl methacrylate); poly(vinylpyrrolidone) (“PVP”);polyacrylic acid; poly(ethyloxazoline); poly(dimethyl acrylamide);phospholipids, for example, phosphoryl choline derivatives;polysulfobetains; acrylic esters, polysaccharides and carbohydrates, forexample, hyaluronic acid, dextran, hydroxyethyl cellulose, hydroxylpropyl cellulose, gellan gum, guar gum, heparan sulfate, chondritinsulfate, heparin, and alginate; proteins, for example, gelatin,collagen, albumin, and ovalbumin; polyamino acids; fluorinated polymers,for example, polytetrafluoroethylene (“PTFE”), polyvinylidene fluoride(“PVDF”), and teflon; polypropylene; polyethylene; nylon;poly/ethylvinyl acetate (“EVA”); poly/caprolactone; and poly/ethylenevinyl alcohol (“EVOH”).

The surface of the punctal plug main body may be wholly or partiallycoated. The coating may provide one or more of lubriciousness to aidinsertion, muco-adhesiveness to improve tissue compatibility, andtexture to aid in anchoring the plug within the punctum. Examples ofsuitable coatings include gelatin, collagen, hydroxyethyl methacrylate,PVP, PEG, heparin, chondroitin sulphate, hyaluronic acid, synthetic andnatural proteins, and polysaccharides, thiomers, thiolated derivativesof polyacrylic acid and chitosan, polyacrylic acid, carboxymethylcellulose and the like and combinations thereof.

Certain exemplary embodiments of the punctal plugs of the presentinvention have a main body made of a flexible material that conforms tothe shape of whatever it contacts. Optionally, the punctal plug may havea collarette formed of either a less flexible material than that of themain body or material that too conforms to the shape of whatever itcontacts. When a punctal plug having both a flexible main body and aless flexible collarette is inserted into the lacrimal canaliculus, thecollarette rests on the exterior of the lacrimal punctum and the mainbody of the punctal plug conforms to the shape of the lacrimalcanaliculus. The reservoir and the main body of such punctal plugs arepreferably coterminous. That is, the reservoir of such punctal plugspreferably make up the entirety of the main body, except for thecollarette.

In exemplary embodiments in which one or both of a flexible main bodyand collarette are used, the flexible main body and flexible collarettecan be made of materials that include nylon, polyethylene terephthalate(“PET”), polybutlylene terephthalate (“PBT”), polyethylene,polyurethane, silicone, silicone made from multiple precursors assistedby crosslinkers and catalysts, PTFE, PVDF, and polyolefins. Punctalplugs made of nylon, PET, PBT, polyethylene, PVDF, or polyolefins aretypically manufactured utilizing extrusion, injection molding, orthermoforming. Punctal plugs made of latex, polyurethane, silicone, orPTFE are typically manufactured using solution casting processes.

The punctal plugs of the present invention comprise a reservoir withinthe main body, and the reservoir comprises an active agent-containingmaterial. The material may be any material that is compatible with theactive agent or agents to be delivered by the plug and is capable ofreleasing the active agent in the desired manner, for example, bydissolving or degrading of the material or diffusion of the active agentfrom the material. Any number of material may be used as the activeagent-containing material including polymeric materials, both naturallyoccurring and synthetic, non-polymeric materials including glasses andclays, organic materials, inorganic materials including, porousceramics, lipids, waxes and the like and combinations thereof.Preferably, the active agent containing-material is a polymericmaterial, in which at least one active agent is disposed on, dispersedthroughout, or otherwise contained. The main body is preferablyimpermeable to the active agent, and the reservoir has at least oneopening through which the active agent is released.

The main body has one or more openings communicating with the reservoirat a first end, a second end, or at another location on the main body.In particular exemplary embodiments of the invention, when such punctalplugs are inserted into the lacrimal canaliculus and have opening at theend of the body facing the eye, the active agent is released into thetear fluid of the eye. Alternately, if the punctal plug has an openingin the end of the main body facing the nasolacrimal duct, the activeagent is released into the nasolacrimal duct. In those exemplaryembodiments in which the punctal plug has opening at the end of the bodyfacing the eye and another opening at the end of the body facing thenasolacrimal duct, the active agent is released into both the tear fluidof the eye and the nasolacrimal duct. For those punctal plugs with acollarette, the opening of such punctal plugs is preferably locatedwithin the collarette, preferably the central portion of the collarette.When such punctal plugs are inserted into the lacrimal canaliculus, theopening faces the eye, and the active agent is released into the tearfluid of the eye. The size of the opening will be from about 0.05 mm toabout 2.5 mm and preferably about 0.15 mm to about 0.8 mm. Instead ofone large opening at any one location, multiple small openings may beused.

Processes for manufacturing the punctal plugs useful in accordance withthe present invention are well known. Typically, the punctal plugs aremanufactured by injection molding, cast molding, transfer molding or thelike. Preferably, the reservoir is filled with one or both of at leastone active agent and the active agent-containing material subsequent tothe manufacture of the plug. Additionally, one or more excipients may becombined with the active agent alone or in combination with thepolymeric material.

Depending upon the active agent-containing material selected, the activeagent may be released from the material almost immediately, or theactive agent may be released in a sustained manner over a desired periodof time. For example, a polymeric material may be used that is composedof one or more polymers that are at least partially soluble in water.When such a polymeric material is exposed to the aqueous environment ofthe lacrimal canaliculus or the tear fluid, it preferably will dissolveand release the active agent as it dissolves. The solubility in water ofthe one or more polymers from which the polymeric material is madetypically will be directly proportional to its rate of dissolution.Suitable polymers that are at least partially soluble in water includepoly(ethylene glycol); poly(ethylene oxide); polypropylene glycol);poly(vinyl alcohol); poly(hydroxyethyl methacrylate);poly(vinylpyrrolidone); polyacrylic acid; poly(ethyloxazoline);poly(dimethyl acrylamide); phosolipids, for example, phosphoryl cholinederivatives; polysulfobetains; polysaccharides and carbohydrates,including hyaluronic acid, dextran, hydroxyethyl cellulose, hydroxylpropyl cellulose, gellan gum, guar gum, heparan sulfate, chondritinsulfate, heparin, and alginate; proteins, for example, gelatin,collagen, albumin, and ovalbumin; and polyamino acids. The polymericmaterials in this list may typically be copolymerized or blended withone or both of hydrophobic polymers and monomers.

As an alternate, a non-polymeric material including a lipid, wax, orinorganic material may be used. Suitable non-polymeric materials includelanolin, paraffin, sorbates, lecithin, vitamin A, D, and E, glycerine,sorbitol, mannitol, stearates, fatty acids, lutein, zeaxanthin, taurine,glutathione and the like.

Alternately, the active agent-containing material may be one or morebiodegradable polymers that partially or wholly chemically degrade uponexposure to, for example, biologically active substances typicallypresent in mammals. The biodegradable materials are preferablyhydrolyzable under in vivo conditions. Biodegradation may occur moreslowly than dissolution, and the material may thus comprise one or morebiodegradable polymers if slower, more sustained release of the activeagent is desired.

Suitable biodegradable polymers include polymers and oligomers ofglycolide, lactide, lactones, and other hydroxy acids, and otherbiologically degradable polymers that yield materials that are non-toxicor present as normal metabolites in the body. Preferredpoly(alpha-hydroxy acids) are poly(glycolic acid), poly(2-dioxanone);poly(DL-lactic acid) and poly(L-lactic acid). Other useful polymersinclude poly(amino acids), polycarbonates, poly(anhydrides),poly(orthoesters), poly(phosphazines) and poly(phosphoesters).Polylactones including poly(epsilon-caprolactone),poly(delta-caprolactone), poly(delta-valerolactone) andpoly(gamma-butyrolactone are also useful, as are chitosan, alginates,collagen, and gelatin. In particular aspects of the present invention,the polymeric material comprising the active agent may comprise amixture of one or more dissolvable and bio-degradable polymers.

In a preferred exemplary embodiment, the active agent-containingmaterial is a polymeric material that is combined with at least oneactive agent to form one or more fiber or fiber-like structures, thedimensions of which may be substantially the dimensions of the reservoiror smaller than such dimensions, and one or more of the fibers orfiber-like structures are inserted into the reservoir through theopening in the punctal plug main body. The fibers or fiber-likestructures may be of a size and a shape suitable for insertion into theopening and may be about 0.5 to about 5 mm in length and 0.05 to about 2mm in diameter. If only one fiber or fiber-like structure is used,preferably, the dimensions of the fiber are such that the fiber fitssecurely into the reservoir and remains in the reservoir when thepunctal plug is in use in a wearer's punctum. Thus, the fiber may besymmetrical or asymmetrical, depending upon the shape of the reservoir.The internal walls of the reservoir may be substantially smooth or mayinclude features that aid in maintaining the fiber within the reservoirincluding surfaces with grooves, indentations, roughness or the like inthe interior walls.

Alternately, the fiber containing the active agent or agents may beformed and the plug cast around the fiber. As yet another alternate, thefiber and active agent may be dosed or nano-dosed into the plugreservoir as a melt and allowed to solidify. As still another alternate,the polymer and active agent may be introduced as a solution. Thesolution may comprise monomers, pre-polymers and the like suitable forcross-linking via one or more of irradiation, redox, and thermal radicalpolymerization. As yet another alternate, the fiber may simply be soakedin the active agent before or after insertion in the plug, or it may bebound throughout the silicone or EVA plug.

Preferably the fiber or fiber-like structures are composed of apolymeric material and more preferably a polymeric material that ispolycaprolactone, still more preferably poly(epsilon-caprolactone), andethylene vinyl acetate of molecular weights between about 10,000 and80,0000. About 0 to about 100 weight percent polycaprolactone and about100 to about 0 weight percent of the ethylene vinyl acetate are usedbased on the total weight of the polymeric material and, preferably,about 50 percent each of polycaprolactone and ethylene vinyl acetate isused. The polymeric material used is preferably greater than about 99percent pure and the active agent is preferably greater than about 97percent pure. One of ordinary skill in the art will recognize that incompounding, the conditions under which compounding is carried out willneed to take into account the characteristics of the active agent toensure that the active agents do not become degraded by the process. Thepolycaprolactone and ethylene vinyl acetate preferably are combined withthe desired active agent or agents, micro-compounded, and then extrudedas a fiber. The fibers are then cut to the desired length and insertedinto the reservoir through one or more plug openings.

The amount of active agent used in the plugs of the present inventionwill depend upon the active agent or agents selected, the desired dosesto be delivered via the punctal plug, the desired release rate, and themelting points of the active agent and active agent-containing material.Preferably, the amount used is a therapeutically effective amountmeaning an amount effective to achieve the desired treatment,inhibitory, or prevention effect. Typically, amounts of about 0.05 toabout 8,000 micrograms of active agents may be used.

In certain aspects of the present invention, the reservoir may berefilled with a material after substantially all of the activeagent-containing material has dissolved or degraded and the active agentis released. For example, the new active agent-containing material maybe the same as, or different from, the previous polymeric material, andmay contain at least one active agent that is the same as, or differentfrom the previous active agent. Certain punctal plugs used forparticular applications may preferably be refilled with a material whilethe punctal plugs remain inserted in the lacrimal canaliculus, whileother punctal plugs are typically removed from the lacrimal canaliculus,a new material is added, and the punctal plugs are then reinserted intothe lacrimal canaliculus.

When the active agent-containing material is combined with the activeagent, the material may also contain one or more materials that areinsoluble in water and non-biodegradable, but from which the activeagent can diffuse. For example, if the material is a polymeric material,the material may be composed of one or more polymers that are insolublein water and non-biodegradable. Suitable polymers of this type includecross-liked polymers, cross-linked poly(ethylene glycol), poly(ethyleneoxide), poly(propylene glycol), poly(vinyl alcohol), poly(hydroxyethylmethacrylate), poly(vinylpyrrolidone), polyacrylic acid,poly(ethyloxazoline), and poly(dimethyl acrylamide). These polymers maybe copolymerized or blended with one or both of hydrophobic polymers andmonomers. Additional polymers that are insoluble in water andnon-biodegradable include silicone; silicone blends; siliconeco-polymers including, hydrophilic monomers of pHEMA, polyethyleneglycol, polyvinylpyrrolidone, and glycerol; silicone hydrogel polymers,for example, those described in U.S. Pat. Nos. 5,962,548, 6,020,445,6,099,852, 6,367,929, and 6,822,016, incorporated herein in theirentireties by reference; phosolipids including phosphoryl cholinederivatives; polysulfobetains; polysaccharides and carbohydratesincluding hyaluronic acid, dextran, hydroxyethyl cellulose, hydroxylpropyl cellulose, gellan gum, guar gum, heparan sulfate, chondritinsulfate, and heparin; proteins including albumin and ovalbumin;polyamino acids; fluorinated polymers including PTFE, PVDF, and teflon;polypropylene; polyethylene; nylon; and EVA. Additional examples ofsuitable polymers that are either or both insoluble in water andnon-biodegradable include silicones, hydrophilic coatings,polyurethanes, cyanoacrylates, and polyacrylic acid.

The punctal plugs described herein may be used to deliver various activeagents for the one or more of the treatment, inhibition, and preventionof numerous diseases, allergies and disorders. Each punctal plug may beused to deliver at least one active agent and may be used to deliverdifferent types of active agents. For example, the punctal plugs may beused to deliver alcaftadine, azelastine HCl, emadastine difumerate,epinastine HCl, ketotifen fumerate, levocabastine HCl, olopatadine HCl,pheniramine maleate, and antazoline phosphate for one or more of thetreatment, inhibition, and prevention of allergies. The punctal plugsmay be used to deliver mast cell stabilizers, for example, cromolynsodium, lodoxamide tromethamine, nedocromil sodium, and permirolastpotassium.

After the plugs are filled with the active agent, the plug is sterilizedby any convenient method including ethylene oxide, autoclaving,irradiation, and the like and combination thereof. Preferably,sterilization is carried out through gamma radiation or use of ethyleneoxide.

The punctal plugs may be used to deliver mydriatics and cycloplegicsincluding atropine sulfate, homatropine, scopolamine HBr, cyclopentolateHCl, tropicamide, and phenylephrine HCl. The punctal plugs may be usedto deliver ophthalmic dyes including rose bengal, lissamine green,indocyanine green, fluorexon, and fluorescein.

The punctal plugs may be used to deliver corticosteroids includingdexamethasone sodium phosphate, dexamethasone, fluoromethalone,fluoromethalone acetate, loteprednol etabonate, prednisolone acetate,prednisolone sodium phosphate, medrysone, rimexolone, and fluocinoloneacetonide. The punctal plugs may be used to deliver non-steroidalanti-inflammatory agents including flurbiprofen sodium, suprofen,diclofenac sodium, ketorolac tromethamine, cyclosporine, rapamycinmethotrexate, azathioprine, and bromocriptine.

The punctal plugs may be used to deliver anti-infective agents includingtobramycin, moxifloxacin, ofloxacin, gatifloxacin, ciprofloxacin,gentamicin, sulfisoxazolone diolamine, sodium sulfacetamide, neomycin,propanidine, chlorhexadine, PHMB, vancomycin, polymyxin B, amikacin,norfloxacin, levofloxacin, sulfisoxazole diolamine, sodium sulfacetamidetetracycline, doxycycline, dicloxacillin, cephalexin,amoxicillin/clavulante, ceftriaxone, cefixime, erythromycin, ofloxacin,azithromycin, gentamycin, sulfadiazine, and pyrimethamine.

The punctal plugs may be used to deliver agents for the one or more ofthe treatment, inhibition, and prevention of glaucoma includingepinephrines, for example dipivefrin; alpha-2 adrenergic receptors, forexample, aproclonidine and brimonidine; betablockers includingbetaxolol, carteolol, levobunolol, metipranolol, and timolol; directmiotics, including carbachol and pilocarpine; cholinesterase inhibitors,including physostigmine and echothiophate; carbonic anhydrase inhibitorsincluding acetazolamide, brinzolamide, dorzolamide, and methazolamide;prostoglandins and prostamides including latanoprost, bimatoprost,uravoprost, and unoprostone cidofovir.

The punctal plugs may be used to deliver antiviral agents, includingfomivirsen sodium, foscarnet sodium, ganciclovir sodium, valciclovirHCl, trifluridine, acyclovir, and famciclovir. The punctal plugs may beused to deliver local anesthetics including tetracaine HCl, proparacaineHCl, proparacaine HCl and fluorescein sodium, benoxinate and fluoresceinsodium, and benoxnate and fluorexon disodium. The punctal plugs may beused to deliver antifungal agents including fluconazole, flucytosine,amphotericin B, itraconazole, natamycin and ketocaonazole.

The punctal plugs may be used to deliver analgesics includingacetaminophen and codeine, acetaminophen and hydrocodone, acetaminophen,ketorolac, ibuprofen, and tramadol. The punctal plugs may be used todeliver vasoconstricors including ephedrine hydrochloride, naphazolinehydrochloride, phenylephrine hydrochloride, tetrahydrozolinehydrochloride, and oxymetazoline. Finally, the punctal plugs may be usedto deliver vitamins, antioxidants, and nutraceuticals including vitaminsA, D, and E, lutein, taurine, glutathione, zeaxanthin, fatty acids andthe like.

The active agents delivered by the punctal plugs may be formulated tocontain excipients including synthetic and natural polymers, forexample, polyvinylalcohol, polyethyleneglycol, PAA (polyacrylic acid),hydroxymethyl cellulose, glycerine, hypromelos, polyvinylpyrrolidone,carbopol, propyleneglycol, hydroxypropyl guar, glucam-20, hydroxypropylcellulose, sorbitol, dextrose, polysorbate, mannitol, dextran, modifiedpolysaccharides and gums, phosolipids, and sulphobetains.

Although shown and described is what is believed to be the mostpractical and preferred embodiments, it is apparent that departures fromspecific designs and methods described and shown will suggest themselvesto those skilled in the art and may be used without departing from thespirit and scope of the invention. The present invention is notrestricted to the particular constructions described and illustrated,but should be constructed to cohere with all modifications that may fallwithin the scope of the appended claims.

What is claimed is:
 1. A lacrimal insert for delivering one or moreactive agents, the lacrimal insert comprising: an elongated main bodyhaving a first end and a second end, the elongated main body including areservoir and a threaded portion; a collarette connected to the firstend of the main body and having at least one opening in fluidcommunication with the reservoir, the collarette being concentricallypositioned relative to the elongated main body; and a head sectionconnected to the second end of the elongated main body, the head sectionincluding a flange portion having a lower surface with a spherical coneshape and an upper surface that is substantially flat, and a coneportion; wherein the flange portion and the cone portion beingnon-concentrically positioned relative to the elongated main body. 2.The lacrimal insert for delivering one or more active agents accordingto claim 1, wherein the elongated main body comprises a substantiallycylindrical shape.
 3. The lacrimal insert for delivering one or moreactive agents according to claim 2, wherein the threaded portioncomprises a helical winding extending at least partially along theelongated main body.
 4. The lacrimal insert for delivering one or moreactive agents according to claim 3, wherein the helical winding has apredetermined pitch and rounded edges.
 5. The lacrimal insert fordelivering one or more active agents according to claim 2, wherein thethreaded portion comprises a helical winding extending from thecollarette to the head section.
 6. The lacrimal insert for deliveringone or more active agents according to claim 5, wherein the helicalwinding has a predetermined pitch and rounded edges.
 7. The lacrimalinsert for delivering one or more active agents according to claim 1,wherein the reservoir is positioned within the elongated main body andextends at least partially therethrough.
 8. The lacrimal insert fordelivering one or more active agents according to claim 7, wherein thereservoir comprises one or more active agents for the treatment of oneor more of the eye, nose or throat.
 9. The lacrimal insert fordelivering one or more active agents according to claim 8, wherein theat least one opening in the collarette is configured to release the oneor more active agents.
 10. The lacrimal insert for delivering one ormore active agents according to claim 1, wherein the collarettecomprises a substantially disc shaped structure having a substantiallyflat upper and lower surface.
 11. The lacrimal insert for delivering oneor more active agents according to claim 10, wherein the collarettecomprise a positioning mark on the upper surface.
 12. The lacrimalinsert for delivering one or more active agents according to claim 1,wherein the cone portion of the head section comprises at least oneopening in fluid communication with the reservoir.